In pursuit of health equity, efforts sometimes lack formal goal setting

Tough times for medical group practices can complicate good intentions, pushing longer-term initiatives to the side in favor of immediate improvements in productivity and finances.

Case in point: A recent Deloitte report suggested that more than eight in 10 life sciences and healthcare C-suite executives had health equity improvements as a top-10 goal this year — and more than half expect regulatory pressure to drive the industry toward those efforts.

However, the formalization of those goals still is nascent. A Feb. 13, 2024, MGMA Stat poll found that only about one medical group leader in four (24%) reports that their organization has formal health equity goals, and only another 4% note they are considering adding goals. Almost two-thirds (64%) said they have no formal goals, and another 8% were unsure. The poll had 320 applicable responses.

Feedback from medical group practice leaders in this most recent poll suggests that many of them are working toward improvements to achieve health equity — even though many have no specific goals to achieve or equity-specific metrics to measure and track:

• Overall patient access, as well as many specific efforts in population health management and engaging patients from underserved communities, were frequently noted by respondents who signaled they had no formal goals.
• Many medical group leaders noted they have care goals tied to optimizing preventative measures that they did not necessarily characterize as having a relationship to health equity.
• Several respondents mentioned work on social determinants of health (SDoH) to help address disparities without viewing those efforts through the lens of health equity.

Among practice leaders who did have formal goals around health equity, several initiatives in these aforementioned areas were noted, especially with a focus on ensuring internal staff were educated on what these goals are about and why the organization pursues them.

One respondent told MGMA that their organization focuses on making people aware of what health equity is through regular review of their mission statement and quarterly training on health equity topics. Building that understanding within the organization to create a shared culture was cited as another key effort by another practice leader.

Beyond awareness, medical group practice leaders told MGMA that they create policies of accountability around their goals, as well as assigning leadership responsibilities for data collection, identifying community resources and expanding patient navigation programs.

The emergence of health equity as an improvement priority

A decade ago, the Centers for Medicare & Medicaid Services (CMS) released its first strategic plan around health equity. At that time, the CMS Equity Plan for Improving Quality in Medicare (PDF) outlined the Office of Minority Health’s efforts to drive better understanding and awareness of disparities, as well as solutions and actions to help achieve health equity goals.

For those still determining what health equity means for their organizations, the current CMS Framework for Health Equity 2022-2032 (PDF) might be a good foundation for understanding the topic and implications for practice administrators. The framework outlines five key priorities for CMS on health equity:

1. Expanding collection, reporting and analysis of standardized data
2. Assessing the causes of disparities within CMS programs and addressing inequities in policies and operations to close gaps
3. Building capacity in provider organizations and the healthcare workforce to reduce disparities
4. Advancing language access, health literacy and culturally tailored services
5. Increasing all forms of accessibility to healthcare services and coverage.

There’s further evidence that medical group practices are heading in the right direction, especially around the first of these five priorities, data collection: About half (48%) of medical group leaders reported they added or improved collection of patient demographic or SDoH data in 2023, per a Dec. 19, 2023, MGMA Stat poll.

SDoH or health-related social needs (HRSNs) have become more visible in recent years across the industry, but historically there has been a gap between the work to address them and reimbursement — though some progress is being made. As recently reported by Modern Healthcare, multiple states have received Section 1115 Determination waivers from the Centers for Medicare & Medicaid Services (CMS), allowing their local Medicaid agencies to use state and federal funds to pay for health-related social needs (HRSNs).

Advancements and challenges

• The leaders at Rush University Medical Center in Chicago recently published a look at being an anchor institution for the community as it relates to health equity work, with a “built-in strategy” to offer education, workforce development and care access initiatives.
• Yale Medicine’s “care path” initiative is focusing on standardizing efforts across more than 650 care paths in inpatient, outpatient and emergency settings to address disparities caused by unequal care distribution.
• The development of artificial intelligence (AI) and large language models (LLMs) could be a major boost for healthcare providers looking to address clinical quality measures (CQM).
• The proliferation of programs advancing topics in diversity, equity and inclusion (DEI) in medical schools and residency programs has been disrupted by legislative efforts in many states to restrict public funding of DEI education.

Resources and insights to work toward health equity

• “Managers provide advice on health equity” (Fior Reports)
• "Morgan Health: How employers can take the lead in addressing health equity” (Fierce Healthcare)
• “The business case for health equity” (Physicians Practice)

1. "Open forum on advancing health equity highlights the power of collaboration” (UMass Boston)

• "Shortcomings and opportunities for health equity in pediatrics” (MobiHealthNews)
• “It Starts at the Top: How Boards Can Prioritize Health Equity” (Boardroom Brief)

Insights from the MGMA Podcast Network

On a recent episode of the MGMA Mindful Medicine podcast, Amanda Jensen, program manager of member engagement at MGMA, delved into her own learnings around diversity, equity and inclusion (DEI) and the importance of helping others in healthcare create their own educational journeys.

“Equity and inclusion do not just automatically happen in the workplace,” Jensen said. “I learned that I have a unique position to have critical conversations with people who are like me.” She stressed that making more individuals aware about topics such as equity is meant to be inclusive, not disparaging.

“We're operating, in many ways, in our country right now in a call-out culture, but DEI really operates in a way of trying to call people into the conversation,” Jensen said, especially in healthcare where the issues of health equity can be confronted. For example: maternal mortality — Black women are 2.6 times more likely to die in childbirth than white women, according to CDC data.

One of the ways in which medical group leaders can build conversations and connections around these topics and experiences is through resource groups such as those recently held during the 2023 Leaders Conference hosted by MGMA. In her role, Jensen recruited volunteers to help lead group discussions at the Nashville event and bring those connections forward after the show.

“I believe we're seeing success with this specific program, because we're not making assumptions about what different groups of people need or want to talk about,” Jensen said, “but instead having a posture of listening — and our volunteers are really leading the way with that.”

For healthcare leaders considering setting specific goals in health equity or broader issues in DEI, Jensen said it is important to note that these issues are not new. “A lot of people think that DEI began in 2020,” Jensen said, but the work has been ongoing since the Civil Rights era — and it has paid off for those who have stuck with their goals.

“What we see with these organizations that have really committed to staying the course is that they do better at retaining their employees, the diversity on their teams leads to better innovation, the belonging in the organizations that their employees experience leads to better employee experience overall — their products and services reach larger audiences,” Jensen said.

Even for those organizations that set goals and reach them, Jensen cautioned that “DEI is not an arrival spot — it’s something that we're all consistently working on it in the long term.”

But commitment to these goals is not a given, as many public organizations face new political obstacles in the form of legislation to restrict DEI education and funding in curricula. These efforts complicate what was otherwise a broad trend in academia to emphasize DEI: A recent Association of American Medical Colleges survey found that, out of 101 North American medical schools, about 96% worked to make DEI a focus of learning.

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